Via Juan Williams at Fox News. Yes, that Fox News.
The rollout of the Affordable Care Act has been a “debacle” even according to the administration, but there is more to the confusion than just poorly written code. Take a deeper dive with this quick list from the Washington Post:
“Frustrating.” A “debacle.” That is how President Obama’s own secretary of health and human services, Kathleen Sebelius, has described the rocky launch ofHealthCare.gov. Americans were supposed to begin shopping for insurance coverage on Oct. 1, but millions have been unable to log into the federal online exchange . Congress, meanwhile, shut down the government for 16 days in a dispute over whether to fund the health-care law. As the debate continues, let’s look at some of the most persistent myths about the law — and some new ones that have cropped up.
1. Americans will be forced to buy health insurance.
The health-care law’s individual mandate, despite its name, isn’t meant to force Americans into health plans. Instead, it is supposed to encourage people to purchase coverage by giving them two options: Buy insurance or pay a fine. In 2014, that fine is $95 or 1 percent of an individual’s income, whichever is higher.
The Internal Revenue Service is responsible for collecting this penalty from individuals who indicate on their annual tax filings that they have not purchased coverage. The agency can take the penalty out of a filer’s refund, but beyond that, its ability to recoup those dollars is extremely limited. The IRS cannot, for example, send agents to people’s homes or put liens on their houses. In the health-care law, Congress specifically curtailed the ability to enforce this penalty, giving the IRS fewer ways to collect it than there are for other tax fines.
2. If you like your health plan, you can keep it.
Obama has repeatedly made this key promise about his signature legislation. “If you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance,” he said in June 2012, shortly after the Supreme Court upheld the law.
In truth, the health-care law makes a number of changes to the insurance industry that will affect the nearly 165 million Americans covered by private plans. For one, it requires all health plans to include a wider set of benefits, among them maternity care and mental health services. Employers have responded by increasing premiums by less than 3 percent, on average, to make up for the cost of these new benefits.
The individual market, where 15 million Americans buy their own coverage, will see even bigger changes. Experts estimate that insurers will discontinue at least half of these plans in 2014 because they do not cover the benefits that the Affordable Care Act requires. Some say the number could be even higher, around 75 to 80 percent.
CBS News has reported that more than 2 million people have already received word from their insurers that the health plans they have now won’t be available next year. Customers who receive a cancellation notice will need to shop for new coverage. Those plans could have a higher price tag because they offer more benefits, although many people will receive financial help from the government to buy a new policy.
3. The exchange’s big problem is that it ’s overwhelmed by traffic.
The federal exchange did get a lot of web traffic at first; the White House estimates that 8 million people visited the site in its first four days. To put that in perspective, as one Web developer recently did, that’s more users in HealthCare.gov’s first 24 hours than Twitter had in its first 24 months.
Traffic has decreased since then, and some people have successfully purchased insurance through the online marketplace. That’s led insurance companies to discover an even more serious problem with the exchange: It’s sending inaccurate enrollment data to insurers. Companies are supposed to get a file from the exchange each time someone enrolls in one of their plans. These files include important information such as where the new subscriber lives and how many people are in her family. But insurers say these files are sometimes wrong, listing children as spouses, for instance, or including an address that doesn’t exist.
Some companies have assigned employees to hand-check each file for errors. This works now because few people are enrolling through the exchange. But at some point, insurers expect that they’ll receive thousands of files each week and won’t have the manpower to check each one. If lots of people start signing up before the problem is fixed, insurers worry that they won’t know who actually bought their plans. And without knowing who has subscribed, insurance companies won’t be able to send out membership cards, for example, or begin paying claims for trips to the doctor.
4. The exchanges will transform the insurance industry.
While the federal exchange has gotten much attention in recent weeks, only a small fraction of Americans are expected to use the new marketplace to buy health insurance. The Congressional Budget Office estimates that, by 2023, 24 million people will buy insurance through the state and federal exchanges; that’s about 7 percent of the population. It’s telling that many of the large insurance companies, such as Cigna and UnitedHealthcare, have decided to participate in only a handful of the states’ marketplaces. So far, they don’t see this segment of the market as key to their growth.
The vast majority of Americans will still get their health insurance the way they did before the Affordable Care Act: through their employers or through a public program, mainly Medicare and Medicaid.
5. The health-care law will increase the deficit.
The Congressional Budget Office estimates that, over the next decade, the health-care law will reduce the deficit by $109 billion. That’s because the Affordable Care Act includes new spending cuts and tax increases, which more than offset the cost of expanding health insurance to millions of Americans.
The law’s new revenue sources fall into three main categories. First are cuts to Medicare providers, such as hospitals and doctors. Under the Affordable Care Act, the federal government will pay slightly lower rates.
Second are cuts to private health insurance plans, known as Medicare Advantage plans, that cover Medicare patients. The federal government has, in recent years, paid these private plans more to cover Medicare beneficiaries than it has spent on seniors who sign up for the traditional public program. The health law aims to reduce those differences by cutting Medicare Advantage payments.
Lastly, the law includes new taxes on a number of health-care industries, including hospitals, medical-device makers, insurers and pharmaceutical companies.
New analysis of health care outcomes related to spending reenforce notions that spending is not the problem. Just about everything else it.
Via the New Scientist:
AMERICANS die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on healthcare. That was the startling conclusion of a major report released earlier this year by the US National Research Council (NRC) and the Institute of Medicine (IOM).
It received widespread attention. The New York Times concluded: “It is now shockingly clear that poor health is a much broader and deeper problem than past studies have suggested.”
What it revealed was the extent of the US’s large and growing “health disadvantage”, which shows up as higher rates of disease and injury from birth to age 75 for men and women, rich and poor across all races and ethnicities. The comparison countries – Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands and the UK – generally do much better, although the UK isn’t far behind the US.
The poorer outcomes in the US are reflected in measures as varied as infant mortality, the rate of teen pregnancy, traffic fatalities and heart disease. Even those with health insurance, high incomes, college educations and healthy lifestyles appear to be sicker than their counterparts in other wealthy countries. The US Council on Foreign Relations, a non-partisan think tank, described the report as “a catalog of horrors”.
Findings that prompted this reaction include the fact that the rate of premature births in the US is the highest among the comparison countries and more closely resembles those of sub-Saharan Africa. Premature birth is the most frequent cause of infant death in the US, and the cost to the healthcare system is estimated to top $26 billion a year.
As distressing as all this is, much less attention has been given to the obvious question: why is the US so unwell? The answer, it turns out, is simple and yet deceptively complex: it’s almost everything.
Our health depends on much more than just medical care. Behaviours such as diet, physical activity and even how fast we drive all have profound effects. So do the environments that expose us to health risks or discourage healthy living, as well as social determinants of health, such as education, income and poverty.
The US fares poorly in almost all of these. In addition to many millions of people lacking health insurance, financial barriers to care and a lack of primary care providers compared with other rich countries, people in the US consume more calories, are more sedentary, abuse more drugs and shoot one another more often. The US also lags behind on many measures of education, has higher child poverty and income inequality, and lower social mobility than most other advanced democracies.
The breadth of these causal factors, and the scope of the US health disadvantage they produce, raises some fundamental questions about US society. As the NRC/IOM report noted, solutions exist for many of these health problems, but there is “limited political support among both the public and policymakers to enact the policies and commit the necessary resources”.
One major impediment is that the US, which emphasises self-reliance, individualism and free markets, is resistant to anything that even appears to hint at socialism. Interestingly, as a group, classically liberal nations like the US and the UK – free market-oriented with less regulation, tax and government services – are the least healthy among wealthy democracies.
By contrast, social democratic countries such as Sweden – in which the state emphasises full employment, income protection, housing, education, health and social insurance – enjoy better overall health, although health inequalities within these nations are not always the smallest.
Debates about the relative merits of “cut-throat” US versus “cuddly” Swedish capitalism contend that there are important trade-offs between economic growth and innovation on the one hand, and growing inequality, high poverty and a weak social safety net on the other. Unfortunately, these debates often fail to factor in our health. That needs to change.
And, as it turns out, the US spends plenty on social welfare. It may tax less and spend less on social programmes than most rich democracies, but when you add in tax-based subsidies and private social spending, it ranks as the fifth highest in the world, just after Sweden. What distinguishes the US is how that money is spent. More goes on healthcare – while still leaving many without health insurance or access to care – and less on children, families and the disadvantaged.
Digging into the social determinants of health can be tricky. Social scientists and other researchers are rightly trained not to confuse correlation with causation. But the evidence on the biology of disadvantage – how social and economic conditions affect our health and survival – is rapidly building.
Following the World Health Organization’s 2008 Commission on Social Determinants of Health, countries such as Finland, Australia and Canada are taking a “health in all policies” approach that promotes health through public policies in areas as diverse as transportation, housing and agriculture. In the US these ideas have yet to gain much traction.
Moving beyond the dismal headlines generated by the NRC/IOM report, we can hope that the evidence of a health disadvantage in the US is now so compelling that the terms of the conversation and even the political calculus will begin to change. Then, perhaps, we can start addressing that disadvantage and stop paying for it with our lives.
This article appeared in print under the headline “Paying with our lives?”
Laudan Aron is a senior research associate with the Urban Institute in Washington DC, and was study director for the NRC/IOM report. The opinions are the author’s and do not represent those of the NRC/IOM panel or Urban Institute
Via Ezra Klein at WashPo:
There’s been an interesting conversation over the last week about how young people will fare under health reform. Aaron Smith, executive director of Young Invincibles (and a bona fide young adult) has spent the past few years of his life worrying and working on exactly that question. So I asked him to weigh in. A lightly edited transcript of our conversation follows.
Aaron Smith: I’d begin with the economic landscape because I think that matters here. The young adults we’re talking about are largely low income. They might be in school or in school part-time or in community college. They’re in and out of the workforce. They’re having a tough time landing a steady job with benefits. They don’t make very much money. Many of them were on their parents’ plan growing up. They don’t have a ton of familiarity with the health system. They don’t always know what terms like “deductible” and “co-pay” mean.
But they know they can get sick. More young people than folks over 75 go to the emergency room in a year. It happens frequently enough to them and their friends that they know the costs can be astronomical. Young women are more frequent users of health care; they need things like birth control and regular check-ups. You have young men who don’t have a primary doctor or even remember the last time they went to the doctor. About 15 percent of young adults have a chronic condition and know pretty well that they need health care.
How many of them are uninsured now?
About 19 million young adults 18 to 34 lack health insurance. Our polling shows that less than 5 percent of young people choose not to have it. The number one reason they don’t have it is the cost. Most young people don’t qualify for Medicaid right now even if they have very low incomes because most states just don’t give childless adults Medicaid. That’s one of the biggest changes under Obamacare. If every state expanded Medicaid, about 8 million would qualify for Medicaid. Another 9 million would qualify for subsidies because they make less than 400 percent of poverty.
So then 17 of the 19 million uninsured young people are, in theory, eligible for either subsidies or Medicaid under Obamacare?
That’s right. It’s a pretty phenomenal percentage. So if we do our jobs right, young people will be one of the biggest winners in the health-care law.
But behind this conversation lurks this larger question of whether young people care about health insurance at all. There’s a school of thought that says a lot of the young people who are uninsured or have very little insurance just don’t think they need health insurance. But, and this is anecdotal, that doesn’t fit with my experience very well. Young people I know are really nervous when they don’t have health insurance. They’re really excited if they get a job with benefits. I’m not saying I’ve got a perfectly representative sample, but I’m just not meeting many of these kids who literally don’t care about being insured.
I heard this story on the radio the other day about a young person who said, “I didn’t really feel like I was an adult until I got a job with health insurance.” That’s definitely something I can relate to and that I’ve seen out there in the field. The term “young invincibles” is a health insurance industry term. It tries to explain the fact that young people are disproportionately uninsured. But I think people just dramatically underestimate how hard it is for someone who don’t get health insurance at their job to get health insurance. Less than 50 percent of young adults get employer-sponsored health insurance.
There have been some studies that looked at the choice of whether to accept coverage when you had an employer-based offer. Young people and older people made pretty much the same decisions. Older people were a bit higher, but both were above 70 percent. So when they have the option, the vast majority take it. But when you don’t have the option you have to make tough choices. It’s like deciding not to have a car or living in a bad area. It’s just a tough choice.
But the cost does matter. So is Obamacare actually going to make insurance affordable for this group? Or will it make insurance more expensive for young, healthy people by making it easier for sicker, older people to buy insurance without getting discriminated against?
The first important point is the huge percentage of unemployed young people who get access to either subsidies or Medicaid. So you saw in California that many young people will end up having insurance options that cost them less than $100 or less than $50 simply because their income is low enough to qualify for subsidies. For someone making $20,000 a year, they’re going to have to pay $40 a month for health insurance. That’s a very good deal. And in a state like California, there are also millions of young people who qualify for Medicaid.
Now we’ve identified a population between 300 percent and 400 percent of the federal poverty level that’s going to have more problems. The subsidies aren’t that rich for them, and so whether to buy is a tougher question. They’ll have financial strain. They have financial strain now. That’s why they’re uninsured. If you’re just getting by, then $200 a month can be a lot. That’s where education can be key. It can still make good financial sense to be covered because there are real risks. But I think, in general, it will be a good enough deal to sign up. We saw that in Massachusetts where youth uninsurance dropped in half in the first year.
Expand on that a bit. I recognize Massachusetts is a somewhat unusual state. But its health reforms were very similar to the national reforms. They should’ve had the same issues with rate shock and with bringing older and sicker people in. So what did we learn from them?
There were a couple of interesting things in Massachusetts. One is the Massachusetts exchange had what’s called the “young adult” plan. It’s higher deductibles. It’s a bit cheaper in terms of premiums. It’s similar in some ways to the catastrophic plan available under the health-care law. It’s the most popular plan for young adults in the exchange. So that’s one important point: Youth-tailored insurance options are important.
And just to be clear, the federal plan has something similar in this catastrophic plan mainly available to young people, right?
Yes, so there’s a catastrophic plan as part of the health law. There’s not been that much analysis of it. But it’s specifically targeting that young adult population. It has a very high deductible — about $6,000. So it’s not generous coverage. But it meets all the other standards in terms of benefit caps and preventive coverage and no discrimination and so on. For many young people, that will be their cheapest option. Particularly above that 300 percent of poverty line. In California, that was costing about $130 to $150 a month.
What else did we see in Massachusetts?
They also did big public outreach campaigns. They got the Boston Red Sox to do PSAs. They understood there had to be an attitude change and they were very proactive about trying to address it. The polls show health reform in Massachusetts is actually quite popular, even among young people who are now being forced to purchase coverage. And that’s another similarity. There’s a mandate. But it has exceptions. Not many people pay it in Massachusetts. If you’re low-income, it doesn’t apply to you. That’s true nationally, too. The mandate doesn’t apply to you if coverage is more than 8 percent of your income. What we saw in Massachusetts is that people are either exempt or they choose to pay for health insurance, Very few end up paying the mandate.
The last point which has been talked about so much people don’t think about it anymore is the expansion of dependent coverage which has also been very popular. Nationally about three million people are estimated to have gotten back on their parents plan because of the law.
So given all the issues of implementation and the political opposition to the law and the difficulties in various states and the early information about premiums, where do you think this will end up in 2014 and 2015? Do you think young people will sign up or stay away?
I’m pretty hopeful, in part because the experience in Massachusetts showed this model can work. But it will play out differently in different states. A state like California is following the playbook. They’ll do a big promotional campaign. They’re investing in on-the-ground outreach and education. They’re expanding Medicaid so really low-income folks will qualify for health insurance. So I could see it being a huge success in a state like that. But not every state will do that. An important point for young people is that some of the states with the highest rates of youth uninsurance are in the south and some of those states aren’t expanding Medicaid or building their own exchanges. My fear is what happens in those states. So I could see some states coming out and looking much better than other states.
Finding myself stuck in a rut with regards to my sources, I turn to Liz Sidoti of AP News to change it up a bit. Check out her piece on the current obesity crisis, with a nice splash of perspective and political philosophy:
Americans have always been conflicted on what role government should have in their private lives. The scale tilts wildly depending on the issue and the era.
Each day, people, courts and lawmakers wrestle with this constant tension: Where does government’s duty to protect its people end and an individual’s right to choose begin? And when someone’s choice impacts society, how far is too far?
These questions are at the core of the national conversation over America’s obesity epidemic, a private issue that’s become more public as rates rise and stress our healthcare system.
Clear answers about the right private vs. public balance, as with so many things, will never exist. But the ways Americans prefer to tackle this public-health crisis offer clues about where the nation stands today. And as ambiguous as those views are, they may give our leaders guidance about how to constructively address other issues where the line blurs – education, guns, energy, gay marriage, marijuana use and the environment, among others.
Obesity deals with a significantly personal issue – our bodies. But it also has a huge impact on society, given that skyrocketing health care costs are driven in part by the slew of avoidable medical problems it produces.
More than two-thirds of adults, and a third of American children and teens, are obese or overweight. It’s one of the nation’s top three killers, and it’s on the rise.
Views on what to do about it are telling in their contradictions. While Americans are hardly monolithic about it, polling shows that people generally know there’s a serious problem.
Most value personal choice over government involvement to address the crisis; in a recent survey by the Associated Press-NORC Center for Public Affairs Research, 88 percent said individuals bear the most responsibility. But many also see a role for other entities, including government, in fixing it.
To what extent is debatable.
Eight in 10 favor government policies that make it easier for individuals to make healthier choices, such as providing nutrition and exercise guidelines, and three-quarters support funding farmers markets and bike paths.
But people drew the line at government mandates, with more than half opposing taxes on soda pop or junk food, and three-quarters balking at restrictions on what they can buy.
Americans, polls suggest, want government to pave the way for them to make better health, fitness and nutrition choices by giving them tools, resources and access – without forcing them to do anything. Ultimately, they want to choose whether to use bike paths, shop farmers markets or select meals based on calorie counts.
Like in so many other areas of our lives, Americans want the benefits of government help but not the restrictions – give me the tools, then back off.
Even that isn’t always a smooth road. First Lady Michelle Obama faced ribbing from critics and comics alike in 2010 when she rolled out her “Let’s Move!” campaign to instill healthy habits in the nation’s youngest generation.
Yet there was no serious controversy because the campaign focused on marshaling federal resources – and partnering with communities, businesses and schools as well as the entertainment and sports industries – to create awareness and provide information about healthy choices for children. “Let’s Move!” is funded by government, but it doesn’t force anyone to do anything.
But the Obama administration faced heat from critics, including congressional Republicans and parts of the food industry, over changes to the decades-old food pyramid nutrition guidelines. Same story when the Agriculture Department told schools to cut sodium in subsidized meals for low-income children by more than half, use more whole grains, serve low-fat milk and limit kids to one cup of starchy vegetables a week.
That seemed like nothing compared to the backlash New York Mayor Michael Bloomberg – a political independent who has made healthy initiatives a hallmark of his tenure – received with his move to restrict sales of large sugary drinks.
Soda makers, restaurateurs and other businesses sued to block the effort by the Bloomberg-appointed health board. Ten City Council members called on the health board to scrap the rule, and a New York Times poll showed that six in 10 people opposed it in New York – a bastion of liberals who tend to tilt toward bigger government.
Bloomberg’s health department has already banned artificial trans fats in restaurant meals and compelled chain eateries to post calorie counts on menus. Now he is trying to banish sugary and fatty foods from public and private hospitals, also stirring controversy.
Critics usually accuse governments that tell people what to do of running a “nanny state.” It’s nothing new; American history is filled with government efforts to shape personal behavior.
Among the most notable: Prohibition, which from 1920 to 1933 barred making and selling alcohol. Congress repealed the law after it became clear that banning booze didn’t curb many social problems.
-Four decades ago, the federal government required states to enact laws requiring motorcycle helmets in order to get highway construction funds. Much griping ensued. The government also started requiring seatbelts in vehicles around that time. Two decades later, New York became the first state to pass a law requiring people to wear them. The hue and cry over that, too, eventually passed.
-By the 1990s, state and local governments had started to rein in public smoking. Controversy flared, but eventually largely fizzled.
-The most contentious debate between public v. private – abortion – rages on, but it’s different in one fundamental way: Many contend that issue is about someone else’s health, not only your own.
What does this all teach us, other than what we already know – that Americans are generally suspicious of being told what to do?
Those who would regulate more could take refuge in the fact that, for the most part, the outcry fades after a law becomes common practice.
And the regulation-wary can learn, from the obesity debate, that government can, at times, adeptly balance the instinct to control with the ability to facilitate solutions. What might that look like when applied to today’s most contentious topics – to education, to energy, to the environment, to gun control?
In the public’s mixed attitudes about the obesity epidemic, we find a signal to our leaders: Government can stake out effective territory when it provides individuals with what they need to make their own choices.
Whether this model works to lower obesity rates remains to be seen. Consider that 65 percent of people in the AP-NORC poll identified a major reason for the obesity problem as a straightforward one: People don’t want to change. Americans have to make the personal decision to live healthier lives or they’ll simply ignore the resources available.
In the end, if government goes for the nudge rather than the outright shove, and we choose poorly, the only people to blame will be ourselves. Which, conveniently, is what many Americans say they want – the ability to rise and fall on their own, without the people who represent them getting in the way.
EDITOR’S NOTE – Liz Sidoti is the national politics editor for The Associated Press.
So Mitt Romney made an attempt to shore up his conservative credentials with the Paul Ryan pick. Who should think that’s good news?
Both Democrats and conservatives are giddy over Mitt Romney’s selection of Paul Ryan as his running mate, and for the same reason: A looming Medicare battle
Mitt Romney “is taking a colossal risk” by choosing House GOP budget chief Paul Ryan (R-Wis.) as his running mate, says Nate Cohn in The New Republic. Older voters like Medicare the way it is, and Ryan’s proposed massive overhaul of the entitlement program could alienate senior-heavy states like Florida, killing Romney’s White House chances. But at least for now, both sides are welcoming the fight over Ryan’s controversial budget and plan to fundamentally transform Medicare “from a defined benefit plan to a defined contribution plan,” says John Dickerson atSlate. So, which candidate will really benefit from a big debate over Medicare policy?
Americans are ready for Ryan’s plan: “The Obama campaign and liberal super PACs are set to dust off those ‘Mediscare’ TV ads showing Paul Ryan tossing grandma over the cliff,” says Stephen Moore in The Wall Street Journal. But it won’t work this time. Ryan’s “got the facts and the math on his side,” and voters are finally ready to have an “adult conversation” about reforming entitlements. When they learn that Ryan’s plan saves Medicare, not kills it, Romney will not only keep seniors but may even win over “young voters who understand they get stuck with the tab” under the status quo.
“Mediscare: The sequel”
Ryan is a gift to Democrats: You’ll continue to hear “cheerful, defiant statements” from Republicans about how Romney is a genius to tap Ryan and turn the race into “a serious, far-reaching debate” about Medicare and the budget, say Alexander Burns, Maggie Haberman, and Jonathan Martin at Politico. But “don’t buy it.” Off the record, most GOP pros are terrified not only that Romney has “practically ceded the election” but also “that Ryan’s vocal views about overhauling Medicare will be a millstone for other GOP candidates in critical House and Senate races.”
“GOP pros fret over Paul Ryan”
May the best demagogue win: Ryan’s plan and Obama’s actual policy, through ObamaCare, are “not diametrically opposed,” says Kate Pickert atTIME. In fact, both seek to constrain Medicare’s growth to the same rate, and a “robust debate” about their very different, unproven tactics to do so would be great for America. Sadly, it won’t happen this election. Instead of nuance and substance, “expect Romney-Ryan and Obama-Biden to compete to see who can demagogue health care the best” for the next three months. Ugh.
Not much explanation needed.
What do you feel is an appropriate price to save a life?
See this recent Slate article my Matthew Yglesias for more:
Conservatives don’t like Medicaid because they believe programs that tax the rich to transfer resources to the poor are bad for long-term economic growth and violate principles of cosmic justice. But since nobody likes to admit to the existence of a tradeoff, conservatives have lately taken to mounting the bizarre argument that giving health care to low-income poor people doesn’t improve health outcomes.
Now along comes “Mortality and Access to Care Among Adults After State Medicaid Expansions”in the New England Journal of Medicine providing further empirical evidence for the normal view that, yes, health care services help save lives. They looked at New York, Maine, and Arizona—three states that substantially expanded Medicaid eligibility in the aughts—and compared county-level all-cause mortality rates for working age adults in those states as compared to neighboring states. They found that expanding Medicaid coverage to 500,000 new adults was associated with the prevention of about 2,840 deaths.
Harold Pollack and Aaron Carroll run the numbers and find that comes out to about $1 million per year in spending per prevented death. Not a bad deal in my opinion.
Those darn socialists, always expanding the entitlement society! It’s UN-AMERICAN! Government Fat Cats! !@#$$%&*@!!!
The New Deal, The Great Society, Obamacare…they’re destroying MY America!
This gave me a chuckle. Like, isn’t this supposed to be insulting? I’m confused.
Wish I could be posting more, but I’m currently working some long days and sadly, blogging to the ten or twelve of you doesn’t pay as well as my day job. I’ll get back to it soon hopefully.